Lecture 4 Electronic Health Record (Chapter 14)

Learning Objectives... 1.Define electronic health record (EHR). 2.Define electronic medical record (EMR). 3.Define computer-based patient record (CPR). 4.Similarities and differences between the EHR, EMR, and the CPR attributes of the CPR for today’s EHR. IS 531 : Lecture 42

Learning Objectives 6.Meaningful Use and the adoption and use of the EHR in health care industry 7.Benefits associated with the EHR. 8.Concerns in implementation of the EHR. 9.Current status of the EHR. IS 531 : Lecture 43

Electronic Patient Record (EPR) Relevant info for the current episode of care Not necessarily a lifetime record IS 531 : Lecture 44

Electronic Medical Record (EMR) Legal record created in hospitals and ambulatory environments that is the source of data for the EHR. Single encounter/episode of treatment, no info from previous visits or to future visits Structured data (predefined format with discrete data Unstructured data (text report) Electronic imaging (ultrasonography, MRI) IS 531 : Lecture 45

*EMR Components* Results reporting Data repository Decision support Clinical messaging and Documentation Order entry IS 531 : Lecture 46

Electronic Health Record (EHR) Longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting Interoperability standards to exchange info outside a single healthcare delivery system Supports other care-related activities directly or indirectly—evidence-based decision support, quality management, and outcomes reporting IS 531 : Lecture 47

Levels of Automation... Stage 0: Not all ancillary systems (Lab, X- ray, Pharmacy) are operational Stage 1: Major ancillary clinical systems installed Stage 2: A clinical data repository(CDR) stores info from major ancillary clinical systems Stage 3: Basic clinical documentation required, CDR storage retrieval (picture archiving communication systems-PACS) IS 531 : Lecture 48

... Levels of Automation Stage 4: Computerized provider order entry(CPOE), support for evidence-based practice Stage 5:Barcode medication administration (BCMA), radio frequency identification (RFID) integrated with CPOE and pharmacy Stage 6:—Full physician documentation, decision support, alerts, full PACS Stage 7:—Fully electronic paperless environment IS 531 : Lecture 49

Computer-Based Patient Record (CPR) Comprehensive lifetime record Attributes identified by the Institute of Medicine (IOM) provide the basis for today’s understanding of the EHR IS 531 : Lecture 410

EHR Attributes... Secure, reliable access where and when needed Records and manages episodic and longitudinal information Primary information source during care Assists with planning and delivery of evidence-based care IS 531 : Lecture 411

... EHR Attributes Captures data for: – Quality improvement – Utilization review – Risk management – Resource planning – Performance management IS 531 : Lecture 412

... EHR Attributes... EHR Attributes Captures information needed for medical record and reimbursement purposes Longitudinal, masked information supports clinical research, public health reporting, and population health initiatives Supports clinical trials and evidence-based research IS 531 : Lecture 413

Continuity of Care Document (CCD) Intended to improve continuity of care when clients move between various points of care Comprised of summaries from many types of caregivers “Snapshot,” not a comprehensive record IS 531 : Lecture 414

IS 531 : Lecture 415 Meaningful use is using certified electronic health record (EHR) technology to:  Improve quality, safety, efficiency, and reduce health disparities  Engage patients and family  Improve care coordination, and population and public health  Maintain privacy and security of patient health information Meaningful Use

IS 531 : Lecture 416 Meaningful use compliance will result in:  Better clinical outcomes  Improved population health outcomes  Increased transparency and efficiency  Empowered individuals  More robust research data on health systems Meaningful use sets specific objectives that eligible professionals (EPs) and hospitals must achieve to qualify for Centers for Medicare & Medicaid Services (CMS) Incentive Programs. Meaningful Use …

...Meaningful Use Penalties imposed for failure to achieve Meaningful Use by 2015 Stage 1: electronic capture and sharing health info in coded format, use it to track conditions and coordinate care (Cf. Box 14-1,2, pp ) Stage 2: Ability to use HIT at the point of care Stage 3: improvement in safety, quality, efficiency and expanded HER functionality. IS 531 : Lecture 417

General Benefits of the EHR Improved data integrity: – readable, better organized, accurate, complete Improved productivity: – access data whenever, wherever for timely decision Increased quality of care: – tailored views, “dash-board” Increased satisfaction for caregivers: – easy access to client data and related services IS 531 : Lecture 418

Nursing Benefits Decreased redundant data collection Allowed data comparison from prior visits Ongoing access, update record at bedside Improved documentation and quality of care Supported timely decision Etc… IS 531 : Lecture 419

Healthcare Provider Benefits Better/faster/simultaneous data access Improved documentation, reporting Prompted to ensure administration of treatments and medications Supported automation of critical pathways / workflows Improved efficiency: eligibility, early warning of status changes IS 531 : Lecture 420

Healthcare Enterprise Benefits Better record security Fewer lost records Instant notice of eligibility/procedure authorization Decreased need and cost for record storage, x-ray film, filing … Decreased length of stay due to waiting Faster turnaround for accounts Increased compliance with regulatory requirements IS 531 : Lecture 421

Patient Benefits... Decreased wait time for treatment Increased access/control over health information Increased use of best practices/decision support Increased ability to ask informed questions Quicker turnaround time for ordered treatments IS 531 : Lecture 422

... Patient Benefits Greater clarity to discharge instruction Increased responsibility for own care Alerts and reminders for appointments and scheduled tests Increased satisfaction and understanding of choices Issue: When a patient could access his/her own health information like in other online services ? (Pros, Cons) IS 531 : Lecture 423

Driving Forces for EHR Compliance with regulatory and reimbursement issues Meaning Use to improve the quality of care IS 531 : Lecture 424

Issues in EHR Implementation Electronic Infrastructure Common Vocabulary Data Integrity Master File Maintenance Data Ownership Privacy & Confidentiality Development / Maintenance Costs Caregiver Resistance Timeline for Implementation IS 531 : Lecture 425

* Electronic Infrastructure * Requires a linkage of various HIS via a network infrastructure Agreement on nature and format of client data to be stored, exchanged, and retrieved by various internal/external stakeholders Data communication standards Interoperability, comparability, POC data capture of longitudinal electronic record “Master Patient Index (MPI)”: a universal client identifier. IS 531 : Lecture 426

* Standard Vocabulary * To generalize research findings across settings, countries To compare patient outcomes from may sources To facilitate communication with other disciplines and delivery systems IS 531 : Lecture 427

* Data Integrity * Due to incorrect entry, data tampering, system failure Data may be entered/modified from may different encounters “Input mask” to safeguard against incomplete / erroneous entry “Audit trail”: tracking who, when, what changes in each data element Policies and procedures for update/ modify/ recover data IS 531 : Lecture 428

* Master File Maintenance * Frequent update and maintenance Major system updates may change database structure : version control to avoid data lost “Version control”: backup data from old system until new system functions properly IS 531 : Lecture 429

* Data Ownership * Paper medical records are the property of the creators with full responsibilities: storage, accuracy Many providers share / update the same electronic data in many sites, who is the responsible owner in HER ? Meaning Use: patients “own” their data and should have full access IS 531 : Lecture 430

* Privacy & Confidentiality * The easy of data sharing by many people/facilities/agencies may compromise privacy and confidentiality of patient data “Access control”: user-IDs, passwords, authorized access level (Create, Read, Update, Delete) Private encryption keys, biometric authentication “Electronic Signature”: system automatically and permanently affixes user identification, date and time log to each entry IS 531 : Lecture 431

* Development/Maintenance Costs * For a provider office: ~ $54, For a hospital: ~ 5, Not include annual maintenance cost Need “incentives” IS 531 : Lecture 432

* Caregiver Resistance * EHRs are perceived as lacking essential features and awkward/inconvenience to use Some people have been unable / unwilling to use computers ! Professionals don’t want to change their “familiar”, “traditional” practices Rather pay penalties than bear EHR implementing cost May even refuse patients Need “incentives” IS 531 : Lecture 433

* Timeline for Implementation * Rushing to meet the deadline may commit to a poor purchasing decision May sacrifice patient safety Should prepare for culture changes, work redesign in the institution IS 531 : Lecture 434

Current Status Bush called for adoption of the EHR by Departments of Defense, Health and Human Services, Veterans Administration, and Centers for Medicare and Medicaid Services mandated the EHR for their facilities and operations. IS 531 : Lecture 435

Summary Most of the potential benefits associated with the use of health information technology are contingent upon the implementation of the EHR. IS 531 : Lecture 436